Insurance

Feel free to contact your insurance provider to learn about your coverage details. Our team is also available to assist you in obtaining a summary of your benefits. Simply provide us with your carrier name and subscriber ID.

Our office may not have a direct contract with your insurance provider, but that doesn't mean we don't accept your insurance. For carriers we do have a contract with, we offer in-network fees. If you are out of network, we use the base price for the service and apply the coverage percentages corresponding to your out-of-network benefits to determine your out-of-pocket costs. We accept major PPO insurances, but we are not contracted with Medicaid, Medicare, or HMO plans.

Dental insurance operates in a similar way to medical insurance, but with a key difference. The insurance provider covers up to a certain amount in a benefit period, while the patient is responsible for any costs exceeding that limit. It's important to know your plan's maximum allowable amount when considering more expensive treatments. Dental PPO plans typically categorize coverage into preventive, basic, and major services, with varying percentages covered for each. It's important to review your personal benefits to understand your specific coverage. Any costs not covered by insurance are the patient's responsibility.

Dental insurance usually includes a wide range of dental services, such as exams, cleanings, fillings, crowns, oral surgery, and orthodontics. These services are categorized as preventive, basic, and major, with coverage percentages determined for each category (usually 100%, 80%, and 50%). Orthodontic coverage is unique, with specific rules regarding age, covered individuals, and maximum benefits. Typically, orthodontic coverage has a lifetime maximum rather than an annual limit.

A PPO, or preferred provider organization, allows you to see any dentist without needing a referral. However, you can save money by choosing a dentist within the PPO network. This is different from HMO/DHMO plans, which require you to select a primary dentist and only allow you to see other dentists if referred to a specialist. HMO/DHMO plans typically have low costs and minimal copayments for services.

Dental insurance operates similarly to other employer-provided insurances like Medical and Vision. Typically offered by employers, dental insurance involves monthly premiums, provider restrictions, and varying benefits. Unlike medical insurance, dental insurance has a yearly maximum reimbursement limit set by the provider, while medical insurance covers costs after the individual reaches their out-of-pocket maximum.

Most of the time, PPO plans include coverage for two exams and cleanings per calendar year.

Yes, in general, dental implants are covered by insurance. However, there are exceptions and important rules to be aware of before receiving care. For example, if you were already missing a tooth and your insurance has a "missing tooth clause", the dental implant may not be covered. We can provide you with information on the specific rules that apply to your coverage.

Yes, in most cases, orthodontic coverage has specific rules regarding age, eligible plan members, and coverage limits. Typically, there is a lifetime maximum amount rather than an annual limit. We can provide you with details about the rules that apply to your particular coverage.